OBJECTIVES: Sound comparative evidence is essential to demonstrate the value of health technologies but is often lacking. Generic measures of benefit such as quality-adjusted life years (QALYs) allow for an assessment of opportunity costs but fall short in adequately capturing all relevant dimensions of the benefit a specific technology brings. Looking at hearing implants, the goal of the presented study was to develop a new measure of benefit that helps to overcome existing shortcomings in measuring benefits of health technologies.

METHODS: The benefit of using a hearing implant encompasses multiple dimensions. In addition to improved hearing and speech understanding (audiological benefits), safety and reliability of the implant as well as subjective benefits such as wearing comfort are of relevance. This study followed methodical guidelines by OECD and JRC to develop a framework that allows for the aggregation of different empirical measures for each of these dimensions to a single composite indicator of hearing implant benefit. Different techniques for aggregation and imputation of missing data were used and compared.

RESULTS: We computed several composite indicators measuring the benefit of hearing implants. For one of our indicators, we considered two dimensions of benefit: audiological benefit (improvement in speech understanding measured by word recognition score) and subjective benefit (wearing comfort measured by daily wearing time). For aggregation of the two dimensions, we applied an established approach used also for the construction of quality-adjusted life years. We show that the new indicator has an intuitive interpretation and can be computed for a wide range of comparators. It is well suited to complement established measures of benefit in a cost-effectiveness analysis.

CONCLUSIONS: For hearing implants, composite indicators can be used to measure the multiple dimensions of benefit and enable comparative analysis even when data availability is scarce.